PB2291: EFFICACY OF SPLENECTOMY IN SPLENIC MARGINAL ZONE LYMPHOMA
Authors: Yuriy Yevstakhevych, Igor Yevstakhevych, Olga Vygovska, Halyna Lebed’, Oleg Knysh, Maksym Semerak
Journal: HemaSphere (2023)

Topic: 19. Aggressive Non-Hodgkin lymphoma - Clinical Background: Splenic marginal zone lymphoma (SMZL) are often associated with splenomegaly. Large-size spleen causes both abdominal discomfort, cytopenia, regional portal hypertension and a decreased efficacy of chemotherapy. This is why splenectomy is indicated in such cases. Aims: To retrospectively analyze the efficacy of splenectomy in patients with SMZL. Methods: 55 patients with splenic marginal zone lymphoma (SMZL), including 9 patients with splenic lymphoma with villous lymphocytes (SLVL; >20% of villous lymphocytes in the peripheral blood). Results: The indications for open splenectomy (SE), safety and complications, immediate and long-term results of the surgery have been analyzed in 55 patients with SMZL, including 9 patients with with SLVL. Patient’s characteristics were as follows: median age 57.5 [interquartile range 49-64] years, women 61%, stage III 24%, stage IV 76%, splenomegaly 100%, bone marrow infiltration ≥30% lymphoid cells in 74%, monoclonal population of B lymphocytes in blood 48%, anemia 43%, autoimmune hemolytic anemia 15%, thrombocytopenia 52%, and leukopenia 28% of the patients. SE was performed due to diagnostic and therapeutic purposes. Pre-surgical management included vaccination for encapsulated bacteria, antibiotics, heparin, blood transfusions. The technical difficulties of SE in the patients were related to massive splenomegaly, perisplenitis and splenic adhesions, increased vascularity and risk of intraoperative splenic rupture. The postoperative complications occurred in 16% of patients without lethal outcome. The most frequent complications were postoperative bleeding, acute pancreatitis and portal vein and deep vein thrombosis. An accurate diagnosis of SMZL has been established by histological and immunohistochemical examination of removed spleen in 65% of the patients. As a result of the surgery, the great tumorous mass was removed; the abdominal discomfort, cytopenia, immune hemolysis and signs of regional portal hypertension were relieved. 32% of the patients did not need the additional treatment after splenectomy for 5 years, and the remission lasts for more than 12 months in 65% of patients with SMZL and 44% with SLVL. The median overall survival of patients with SMZL after SE was 121 [58-178] months, and patients with SLVL – 51 [10-78] months (р=0.01635) (Fig.1). The event-free survival was not statistically related to the percentage of villous lymphocytes; however, 53% of the patients with SMZL and none with SLVL live for up to 10 years. The immune cytopenias (AIHA, thrombocytopenia) have no significant impact on overall and event-free survival of the patients. SE remains the method of choice for treatment of patients with stage III-IV SMZL, with massive splenomegaly (splenic longitudinal size ≥25 cm), cytopenias caused by hypersplenism and/or immune cytopenias. Summary/Conclusion 1. Splenectomy in SMZL has diagnostic and therapeutic indications. Histological and immunohistochemical examination of the spleen is the most reliable method for the diagnosis and differential diagnosis of SMZL; 2. Within 5 years after removal of the spleen, 32% of patients do not need additional treatment; 3. Postoperative complications occur in 16% of patients in the absence of mortality; 4. The presence of immune cytopenias (AIHA, thrombocytopenia) does not significantly affect the overall and event-free survival of the patients.Keywords: Splenic marginal zone lymphoma, Splenectomy